Healthwatch and user led organisations

1. Healthwatch and user led organisations Frances Hasler, April 2012 (With acknowledgements to Department of Health, for the diagrams and some of the slide content)

2. The new system…strengthening the collective voice ‘National champion voice’ DH – Secretary of State advisory advisory HealthWatch England NHS Commissioning Board respond in writing CQC Monitor continuous dialogue Ombudsman Arrangements will ensure sharing of information to involve, consult and protect the public ‘Local champion voice’ Local authority influencing Local HealthWatch health and well being board OSC / scrutiny function Community groups, Voluntary organisations Clinical Commissioning Groups Mental health Older people Working age individuals Disability groups Providers BME groups Carers …others

3. Local and national Healthwatch • Strengthening the voice of patients, users of services and the public and to help achieve this: • Local Healthwatch organisations to be the local consumer voice • Healthwatch England will be a national independent consumer champion • Continuity of existing arrangements: • local authorities will have duty to deliver local Healthwatch • It will continue to be for health and social care • What will be different: • from influence to decision making with a seat on health and wellbeing board. • help individuals as well as understand and present community views (Providing advice and information about access to and choice in health and social care services, and either providing, or signposting to, advocacy for those wishing to make an NHS complaint) • Healthwatch England will be used nationally by Secretary of State, Monitor, NHS Commissioning Board as well as CQC

4. The way local Healthwatch will work • A requirement on local Healthwatch to carry out its work in a way that is representative of people who live in the local authority's area, and people who use services (whether or not they live there). It includes people who live there but use services elsewhere. • Local Healthwatch must be a social enterprise; regulations will set out the criteria such a body must fulfil (for example that it is non-profit-distributing). • Similarly to LINks, it will be open to all local people and local community organisations. Also similarly to LINks, a local Healthwatch can not be part of a local authority or health trust • Although local Healthwatch may subcontract or work in partnership in order to fulfil its role, there will only be one local Healthwatch body in each area • Local Healthwatch will be carrying out public functions, so will be subject to Equality Act, also Freedom of Information and Data Protection laws.

5. Strengths of local Healthwatch • A clear route to influencing local commissioning, having a direct voice on the local health and wellbeing board. • Regulations will make sure that relevant bodies (including Healthwatch England) have to respond to information requests or reports or recommendations made by local Healthwatch • Back up from Healthwatch England, which will provide general advice and assistance to local Healthwatch, and a route to influence national issues where necessary. • Healthwatch England can also make a formal advance to a local authority where the local Healthwatch is in difficulty. • Local Healthwatch will be a clear, recognisable entity, through use of the unified Healthwatch “brand” to help to make it more accessible to local people

6. Health and wellbeing boards The Health and Social Care Bill: • Sets up Health and wellbeing boards (HWBs) as council Committees • Establishes a core membership, with flexibility to expand locally • Mutual obligation on councils and NHS commissioners to undertake Joint Strategic Needs Assessment (JSNA)+ joint health and wellbeing strategies • Sets expectation of alignment of health, social care, public health (and other) commissioning plans • Promotes joint commissioning and integrated provision • Sets a duty for HWBs to involve users and the public in JSNA and JHWS • Gives HWBs a role in annual assessment of clinical commissioning groups (also a non-statutory role in their initial authorisation) • Between 8 and 16 members (ideally)

7. HWBs are not operational bodies, but: They set priorities, and provide shared system leadership They set a context, a common purpose, and shared priorities They promote collaboration and service integration They bring together key elements of public services in one Executive body They are focussed on outcomes, not just services They can make things happen across the public sector HWB working in partnership: a joint strategy to underpin commissioning of services, ensuring alignment of service commissioning plans (health and social care, children and adults) promoting integrated commissioning andprovision working in partnership on the causes of ill-health enabling service change where required engaging the public and listening to the public’s views aligning the resources of local organisations What will Boards actually do?

8. Clinical Commissioning Groups • Responsible for most of the NHS budget • Helped by Commissioning Support Organisations • Locally controlled; including ‘lay’ representation • Must engage: CCGs need to be able to show they will ensure inclusion of patients, carers, public, communities of interest and geography, • It should be evident how the views of individual patients are translated into commissioning and how shared decision-making with patients, about their care, is promoted.

9. NHS Commissioning Board • The NHS Commissioning Board is a major part of the Government's plan to modernise NHS. It will: • directly commission certain services including: primary medical care, specialised commissioning, offender and some military health; • promote patient choice; ensure a comprehensive system of Clinical Commissioning Groups, and supporting and holding them to account; • allocate of, and account for, NHS resources; • and reduce inequalities in access to healthcare • It will establish a culture and leadership approach which puts engagement and involvement at its heart • Around three quarters of the Board’s staff will work in local offices and the four commissioning sectors. • There will be a National Director of Patient Engagement, Insight and Informatics alongside medical, nursing and operations directors

10. Board as: Board as: Board as: Board as: Board as: • Facilitator of effective commissioning • Resource for consortia • Exemplar of an engaging organisation • Champion of engagement and choice • Upholder of the NHS Constitution • Consortia authorisation, operation and accountability • Enabler of public accountability • User of system insight • Engaging organisation • Patient and public voice at every level • Leader of public opinion • Strategic partner • Commissioner • User of insight and patient experience • Quality improver • Enabler of choice • Engaging organisation NHS Commissioning Board – roles Engagement, Involvement and Choice Leading the Commissioning System Ensuring the Commissioning System Supporting Commissioning Acting as a Commissioner Corporate Body 10

11. Health and Wellbeing Boards and the NHS Commissioning Board • Key relationship of HWBs and Healthwatch in respect of health care commissioning is with local Clinical Commissioning Groups • But; they also need to work with the NHS Commissioning Board • As commissioners of primary care and specialist services (e.g. specialist cancer services) • As holders of the contract with clinical commissioning groups (eg on authorisation and annual assessments) • With a national role to ensure the NHS delivers better outcomes within available resources • And with clinical networks and senates (e.g. on best practice, service re-design and service reconfiguration) -

12. Opportunities for user led organisations • Huge emphasis on ‘user voice’ • Everyone learning together • Freedom to create a Healthwatch that fits the local situation • Drawing on existing local resources to get best quality and value of service • Emphasis on making sure that less heard voices are included • Local Healthwatch organisations set their priorities based upon information and intelligence gathered on local health and social care • Strong emphasis on collaboration, building relationships, local HW as a critical friend on the health and wellbeing board • Some strong local CCG pathfinders, already including VCS

13. Potential challenges for user led organisations • Healthwatch being seen as the only voice or the ‘safe’ voice • Healthwatch absorbing available resource • Route to influence for specialist services still not clear • CCGs more focused on statutory partners than on VCS • Disruption of existing arrangements for involvement, information and advocacy • Too complex to make an impact

14. Programme Timescales – Health and Wellbeing Boards and HealthWatch HWBs operate on non-statutory basis, produce JHWS and input to commissioning plans Shadow running HWBs, begin to refresh JSNAs April 2013 HWBs fully operational in every upper-tier local authority, local Health-watch start date HWB early implementers, Healthwatch pathfinders, emerging clinical commissioning groups, share learning to support implementation October; Start date and Healthwatch England 14

15. How can you develop partnerships with Healthwatch and HWBs? • Healthwatch will need to have really effective networks to be able to do its job • You are well-established as a “voice” for people who use health and social care services • You are linked in to other user organisations; you know how to “sign-post” • Health and Wellbeing boards need to take a broad perspective across public services. They also need to get citizens to look after their own health better • You see disabled people as “whole people” in a “whole system”; they may need support with social care, housing, education etc, not just health care • Don’t wait for these new bodies to look for you; go and introduce yourselves!

16. Further information Voluntary sector support • DH strategic partners – Disability Rights UK; Regional voices (LVSC); National Voices, etc. Online • http://knowledgehub.local.gov – search for “health and wellbeing boards” • www.healthandcare.dh.gov.uk – search for “healthwatch” • www.london.nhs.uk – search for “clinical commissioning groups” • www.cqc.org.uk – search for “healthwatch”